Provider Demographics
NPI:1528074697
Name:BARNHART, KEITH A (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:BARNHART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W. LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60520
Mailing Address - Country:US
Mailing Address - Phone:815-286-3303
Mailing Address - Fax:815-286-9249
Practice Address - Street 1:165 W. LINCOLN AVE.
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:IL
Practice Address - Zip Code:60520
Practice Address - Country:US
Practice Address - Phone:815-286-3303
Practice Address - Fax:815-286-9249
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice